Transcript hospital_epidemiologist.ppt

EPIDEMIOLOGY
KSU
College of Applied Medical Sciences
CHS 334
Epidemiology
Mohammed S. Alnaif, PhD
[email protected]
29/10/1437
Dr. Mohammed ALnaif
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Hospital Epidemiology
Nosocomial infection
Any infection that is not present or
incubating at the time the patient is
admitted to the hospital
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Hospital Epidemiology
Why do we need hospital epidemiology??
Hospitals are complex institutions where
patients go to have their health problem
diagnosed and treated
However, hospitals and medical/surgical
interventions introduce risks that may
harm a patient’s health
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Hospital Epidemiology
Consequences of Nosocomial Infections
 Additional morbidity
 Prolonged hospitalization
 Long-term physical, developmental
and neurological sequelae
 Increased cost of hospitalization
 Death
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Hospital Epidemiology
Challenges to the hospital epidemiologist
 Make a hospital safe
◦ Prevent harm to the patient and employees
 initial focus on infectious diseases
 increasingly all adverse (harmful) events are
targets
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Improve hospital efficiency
◦ Eliminate unnecessary costs
◦ Eliminate wasteful practices
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Hospital Epidemiology
What is hospital epidemiology?
The fundamental roles of hospital
epidemiology are to:
• Identify risks
• Understand risks
• Eliminate or minimize risks
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Hospital Epidemiology
What is the role of hospital epidemiology?
Identify risks to patient’s health
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Find nosocomial infections
• surveillance
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Identify and study risk factors for
nosocomial infection
• understand epidemiologic principles and methods
• case-control and cohort studies, bias, confounding
• understand nosocomial pathogens
• what is it about hospitalization that increases
risk?
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Hospital Epidemiology
What is the role of hospital epidemiology?
Eliminate or minimize risks to a patient’s health
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Organize care to minimize risk
• eliminate risk factors
• work around risk factors
• develop improved policies and procedures
 educate physicians and nurses regarding risks
 study risk factors to learn more about them and
how to eliminate them
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Hospital Epidemiology
Responsibilities of the Infection Control Program
 Surveillance of nosocomial infections
 Outbreak investigation
 Develop written policies for isolation of patients
 Development of written policies to reduce risk
from patient care practices
 Cooperation with occupational health
 Cooperation with quality improvement
program
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Hospital Epidemiology
Responsibilities of the Infection Control Program
 Education of hospital staff on infection control
 Ongoing review of all aseptic, isolation and
sanitation techniques
 Monitoring of antibiotic utilization
 Monitoring of antibiotic resistant organisms
 Eliminate wasteful or unnecessary practices
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Hospital Epidemiology
Areas of interest to a hospital epidemiologist
• Surveillance for nosocomial infection
• bloodstream infections
• pneumonia
• urinary tract infections
• surgical wound infections
 Patterns of transmission of nosocomial infections
 Outbreak investigation
 Isolation precautions
 Evaluation of exposures
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Hospital Epidemiology
Areas of interest to a hospital epidemiologist
 Employee health
 Disinfection and sterilization
 Hospital engineering and environment
• water supply
• air filtration
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Reviewing policies and procedures for patient
care
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Hospital Epidemiology
Areas of interest to a hospital epidemiologist
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Antibiotic use
Antibiotic resistant pathogens
Microbiology support
National regulations on infection control
Infection control committee
Quantitative methods in epidemiology
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Hospital Epidemiology
Organizing for Infection Control
 Requires cooperation, understanding and
support of hospital administration and
medical/surgical/nursing leadership
 There is no simple formula:
• Every hospital is different
• Every hospital’s problems are different
• Every hospital’s personnel are different
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The hospital must develop its own unique
program
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Hospital Epidemiology
Essential Components of an Effective Infection
Control Program
 One full time infection control practitioner
per 250 beds
• optimal ratio may be different
A physician with training and expertise in
infection control
 Surveillance and feedback of rates to
clinicians
 Control activities (interventions, policies,
training)
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Hospital Epidemiology
•The quality of a hospital's or health center's
infection control program is a reflection of the
overall standard of care provided by that
institution.
•Good infection control programs reduce
nosocomial infections, length of stay in the
hospital, and costs associated with
hospitalization.
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Hospital Epidemiology
•Countries with developed health care systems
have responded to the need to control hospital
infections, by establishing infection control
programs that span the spectrum of hospital
practice and clinical activity and provide
means of evaluating the outcome of infection
by clinical audit.
•Good programs develop standards for
quality care of patients that are integrated into
clinical practice.
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Hospital Epidemiology
•In developing health care programs, however,
the situation is different. Infection control
programs are either in their infancy or
nonexistent.
•Individual hospitals and physicians struggle
to establish programs with little support from
policy makers and government officials.
•Infection control is considered a low priority.
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Hospital Epidemiology
Mission
The mission of the Department of Hospital
Epidemiology and Infection Control at the Johns
Hopkins Hospital is to support the institution's
tripartite mission of research, teaching, and
patient care; to promote patient safety by
reducing the risk of acquiring and transmitting
infections; and to be a leader in healthcare
epidemiology and infection control.
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Hospital Epidemiology
The Department of Hospital Epidemiology Hospital
Epidemiology Departmental Functions
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Perform comprehensive surveillance for
healthcare-associated infections and
epidemiologically significant organisms
Identify and investigate clusters or
outbreaks of infection
Analyze procedure and device-associated
infections
Create evidence-based interventions to
prevent healthcare-associated infections
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Hospital Epidemiology
The Department of Hospital Epidemiology Hospital
Epidemiology Departmental Functions
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Evaluate methods and technologies to reduce
transmission of pathogens within the institution
Create and maintain appropriate infection
control policies
Develop and maintain educational programs
regarding infection control for all hospital
employees, physicians, and trainees
Provide consultation to health care providers in
the assessment and management of patients and
employees with communicable diseases
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Hospital Epidemiology
The Department of Hospital Epidemiology
Hospital Epidemiology Departmental Functions
• Provide input for the content and scope of
occupational health and safety programs
related to infection control and prevention
• Advise senior leadership on issues related to
reduction of infection risks and regulatory
requirements
• Administer ongoing programs and initiatives
for continuous quality assessment, quality
improvement, and infection risk reduction
(e.g. hand hygiene promotion and monitoring).
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The Infection Control Committee
•The modern hospital epidemiologist has
broad perspectives and influence across clinical
departmental lines.
•The opportunities to improve patient care by
expanding traditional areas of focus beyond
infection control are great.
•Useful skills include epidemiology,
communication, and respect for colleagues.
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The Infection Control Committee
•The hospital epidemiologist needs training in
methods for surveillance, prevention, and
control of nosocomial infections.
•The hospital epidemiologist also must know
how to apply these methods to other areas,
including the epidemiology of noninfectious
adverse outcomes of medical care.
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The Infection Control Committee
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Hospital epidemiologists are professionals
who use their knowledge and skills to
determine the potential causes of disease and
find out how diseases spread.
• Hospital epidemiologists translate their
expertise into institutional policy and gain the
support of administrators through the
infection control committee.
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The Infection Control Committee
•The infection control committee is the arm of
hospital administration that regulates most
infection control activities throughout the
organization.
•Committee members have the important task
of helping disseminate information to all
important hospital constituencies.
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The Infection Control Committee
Purpose of the Infection Control Committee
•The infection control committee is responsible
for assuring that the internal hospital
environment minimizes the exposure of both
patients and hospital personnel to infectious
complications. It therefore develops policies and
procedures relative to infection control and
assures accurate reporting of infections
occurring in the hospital.
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The Infection Control Committee
Purpose of the Infection Control Committee
•The committee's purpose is to ratify the ideas
of the infection control team and to disseminate
infection control information.
•The committee provides the political support
that empowers the infection control team to
implement infection control policies.
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The Infection Control Committee
Purpose of the Infection Control Committee
•Committee members who understand the
policies will take critical information to their
work areas where they can relay it to peers.
•The committee itself does not do the actual
work of infection control and rarely generates
independent ideas.
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The Infection Control Committee
Committee Membership
•The hospital epidemiologist should recruit
people who can help the committee meet its
goals.
•The committee should include a core group
that does the real day-to-day work of infection
control.
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The Infection Control Committee
Committee Membership
•The infection control "team" should includes
the hospital epidemiologist, the infection
control professionals, the clinical
microbiologist, and the employee health
director, the people who perform surveillance,
analyze trends, and develop policies.
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The Infection Control Committee
Committee Membership
•Other members should represent important
department, depending on the structure of the
health care organization; administration,
nursing, family practice, internal medicine,
surgery, pediatrics, pharmacy, and central
services.
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The Infection Control Committee
Committee Chair
•The chair of the infection control committee
is usually the hospital epidemiologist.
•He or she is often an infectious disease
specialist or medical microbiologist with
training in infection control.
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The Infection Control Committee
Logistics
•The committee should meet at a set time and
place monthly or quarterly, on the same week
of the same month and day of the week.
•The committee members should receive the
agenda several days in advance to remind
them of the meeting and to allow them to
prepare for it.
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The Infection Control Committee
Getting Things Done
•To keep things running smoothly in today's
bureaucratic environment, the hospital epidemiologists
must prepare extensively before each meeting.
•He or she must know who is in the power structure
and gain their support ahead of time.
•Once he or she has gained the administrator's
approval, you should have the authority to implement
the policy as needed.
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The Infection Control Committee
Getting Things Done
•The hospital epidemiologist should consult
with persons who have expertise in the area
addressed by the proposed policy.
•It would be wise to have the expert present
relevant background data at the infection
control meeting.
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The Infection Control Committee
Getting Things Done
•Finally, you should identify people who
are likely to oppose your goal.
•If you talk with opponents individually
in a non-confrontational manner before
the meeting, you may disarm them and
win their support.
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The Infection Control Committee
Minutes
•The minutes of the infection control
committee are a legal document.
•They record the topics that the
committee discussed and the policies or
procedures that the committee
approved.
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The Infection Control Committee
Minutes
•An appointed secretary should
compose them with care.
•Copies should be sent to committee
members for review.
•The committee should approve the
minutes at the next scheduled meeting.
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The Infection Control Committee
Meeting Agenda
•The agenda should be structured so that the
meeting will finish within its allotted time.
• "Old business" should be limited to updates
on items of ongoing interest, for example
outbreaks, TB, or antibiotic-resistant
organisms. "New business" at each meeting
should include a brief summary of
surveillance data.
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The Infection Control Committee
Meeting Agenda
•Overly detailed reports of infection
rates usually do not interest the full
committee.
•You should discuss new policies or
procedures and substantial revisions to
current protocols.
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The Infection Control Committee
Meeting Agenda
•You should try approving one new
policy or procedure per meeting and do
not schedule a policy for discussion until
your team has thoroughly reviewed the
literature and sought the advice of
clinical experts.
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The Infection Control Committee
Reassessment
•The infection control committee should
periodically reassess its performance.
•Infection control team members should list
and evaluate their accomplishments and
state their priorities.
•This way the infection control committee
can adapt to changes in the health care
environment.
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THANK YOU
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